State's Doctors At Odds Over Medical Marijuana: Compassionate Solution Or A Reckless Leap?

WILLIAM WEIR, bweir@courant.comThe Hartford Courant

Years of debate and fine-tuning in the state legislature over allowing medical marijuana still have not settled all the questions Connecticut doctors have about medical marijuana. Is it, as some contend, a humane solution for patients who can't get relief from other medicines, or a reckless move toward something that hasn't been fully tested scientifically?

The Connecticut State Medical Society, which has a membership of about 7,000 practicing and training physicians, opposed the bill.

"On one hand, we're asked to be scientific and use evidence-based medicine," said Dr. Michael Krinsky, the medical society's president. "On the other hand, we're being legislated to by people who don't practice medicine, telling us this is fine to do, based on rather flimsy evidence."

While it may be true that marijuana could be medically beneficial for some patients, there hasn't been enough research to confirm this, Krinsky said. "The science is not quite there yet."

The fact that federal regulations do not recognize medical marijuana also causes some concern.

"That's a very difficult position to put a physician in," he said.

In 2009, U.S. Attorney General Eric Holder said he would not prosecute physicians or patients acting under state medical marijuana laws, as long as they did so in good faith. The federal government maintained a hands-off approach to state marijuana laws until late last year, when federal agents began cracking down on California dispensaries.

"I think there's some anxiety about what the federal government's attitude will be about it," said Dr. Andrew Salner, chief of the department of radiation oncology at Hartford Hospital, who has long been an advocate for medical marijuana.

Salner said he doesn't believe federal regulations will be a problem in Connecticut.

"Clearly, there's a groundswell that this is the right thing to do for people who don't respond to other medications," he said.

The federal actions in California caused Delaware Gov. Jack Markell to end the state's regulated marijuana dispensary program in February, less than a year after the state created it.

But the California crackdown hasn't caused any concern in Maine, which has allowed marijuana dispensaries since 2009, said Andrew MacLean, deputy executive vice president at the Maine Medical Association. For one thing, he said, Maine is much smaller than California. Also, he said, Maine has kept much tighter control over the dispensaries and the relationship between medical marijuana practitioners and patients.

Since 1999, Maine had allowed doctors to issue certificates for the use of medicinal marijuana, but there was no place for patients to legally obtain it until 2009. Originally, MacLean said, his organization and most doctors in the state opposed medical marijuana. But the move toward regulated dispensaries — plus 10 years of public discussion — changed that.

"I would say that, yes, [doctors] were resistant," MacLean said. "We opposed the legislation the first time around, but I think opinions among physicians, as among the general public, have evolved."

While conventional medications go through a rigorous approval process from theU.S. Food and Drug Administration, Krinsky said, marijuana hasn't had the same kind of scrutiny. He also wonders how dosages of marijuana would be prescribed.

"Does a physician prescribe one toke or two?" he said.

As for dosages, Salner said, "I think each person needs to do that by trial and error to see what works for them. Generally speaking, a small amount will work."

Salner said he estimates that 1 percent of the patients he sees can benefit from medical marijuana. He has for the last few years occasionally suggested it to patients.

"I'll recommend it, and some patients say, 'Oh, yeah, I know where I can get it,'" he said. "Others have said they've already tried it. And other patients say, 'I wouldn't dare, that's illegal and I wouldn't put myself or family at risk by going to someone on the street.'"

A law allowing medical marijuana would eliminate that risk, Salner said.

"If I tell a patient that they might benefit from medical marijuana for their nausea and pain, I put myself at risk and making that recommendation puts [patients] at risk," he said.

Dr. Kelly Johnson-Arbor, a toxicologist at Hartford Hospital, said allowing medical marijuana in the state "is a good idea in principle," but adds that she has several questions about it. For instance, how would pharmacies dispensing marijuana protect themselves against robberies, and how would residents react to a marijuana dispensary in their neighborhood?

"I think there are so many details that have to be worked out," she said.